Oncotarget-2016

Oncotarget1www.impactjournals.com/oncotarget
www.impactjournals.com/oncotarget/ Oncotarget, Advance Publications 2016
Blocking the PAH2 domain of Sin3A inhibits tumorigenesis and
confers retinoid sensitivity in triple negative breast cancer
Nidhi Bansal1
, Almudena Bosch1,*
, Boris Leibovitch1,*
, Lutecia Pereira2
, Elena Cubedo2
,
Jianshi Yu3
, Keely Pierzchalski3
, Jace W. Jones3
, Melissa Fishel1
, Maureen Kane3
,
Arthur Zelent2
, Samuel Waxman1
, Eduardo Farias1
1
The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2
Division of Hemato-Oncology, Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine,
University of Miami, Miami, FL, USA
3
Department of Pharmaceutical Sciences, University of Maryland, School of Pharmacy, Baltimore, MD, USA
*
These authors contributed equally to this work
Correspondence to: Samuel Waxman, email: Samuel.waxman@mssm.edu
Eduardo Farias, email: Eduardo.farias@mssm.edu
Keywords: Sin3A, SID decoys, triple negative breast cancer, retinoids, metastases
Received: March 11, 2016 Accepted: May 05, 2016 Published: June 07, 2016
ABSTRACT
Triple negative breast cancer (TNBC) frequently relapses locally, regionally or
as systemic metastases. Development of targeted therapy that offers significant
survival benefit in TNBC is an unmet clinical need. We have previously reported that
blocking interactions between PAH2 domain of chromatin regulator Sin3A and the Sin3
interaction domain (SID) containing proteins by SID decoys result in EMT reversal,
and re-expression of genes associated with differentiation. Here we report a novel and
therapeutically relevant combinatorial use of SID decoys. SID decoys activate RARα/β
pathways that are enhanced in combination with RARα-selective agonist AM80 to
induce morphogenesis and inhibit tumorsphere formation. These findings correlate with
inhibition of mammary hyperplasia and a significant increase in tumor-free survival
in MMTV-Myc oncomice treated with a small molecule mimetic of SID (C16). Further,
in two well-established mouse TNBC models we show that treatment with C16-AM80
combination has marked anti-tumor effects, prevents lung metastases and seeding of
tumor cells to bone marrow. This correlated to a remarkable 100% increase in disease-
free survival with a possibility of “cure” in mice bearing a TNBC-like tumor. Targeting
Sin3A by C16 alone or in combination with AM80 may thus be a promising adjuvant
therapy for treating or preventing metastatic TNBC.
INTRODUCTION
Triple Negative Breast Cancer (TNBC), representing
15–20% of all breast cancers, is an aggressive subtype
with high rate of relapse, chemoresistance and decreased
overall survival. Characterized as both Estrogen and
Progesterone receptor negative, TNBC also lacks
overexpression of the HER2 receptor [1]. This, along with
molecular heterogeneity and paucity of clinically validated
drug targets, contributes to the poor prognosis of TNBC.
TNBC patients often receive conventional chemotherapy
that has shown modest survival benefit [2, 3]. To increase
the overall survival and reduce the relapse rate in TNBC
patients, there is an urgent need to identify novel targeted
therapeutics. We have previously reported that the
chromatin remodeling protein Sin3A is a potential drug
target in TNBC [4, 5]. We have developed peptides and
small molecule mimetic inhibitors (SMIs) that block
protein-protein interactions between the PAH2 domain
of Sin3A and Sin3-interaction domain (SID) containing
chromatin-associated factors like MAD1 and PF1 [6, 7].
This interference results in basal to luminal differentiation
by epigenetic modulation and transcriptional repression
of genes that promote epithelial to mesenchymal
transition, invasion and stemness [4, 6, 7]. The potential
of SID decoys is further accentuated by their ability to
modulate therapeutically targetable signaling pathways,
[6, 7] opening the avenue for combinatorial therapies that

target specific vulnerabilities and are fundamental for an
improved clinical outcome.
One of the pathways that is inactivated in many
breast cancers, including TNBCs, is the retinoid pathway
[8–10]. Retinoids are a family of endogenous and synthetic
signaling molecules related to Vitamin A that control
diverse cellular functions including, cell proliferation,
differentiation and organ development [11]. Retinoids
bind to two different families of nuclear retinoic acid
(RA) receptors, the retinoic acid receptors (RARs) and the
retinoid X receptors (RXRs) each with three subtypes (α,
β, γ). All-trans-retinoic acid (atRA), a biologically active
form of Vitamin A and a cytodifferentiating agent is being
successfully used for the treatment of acute promyelocytic
leukemia (APL) in which RARα is fused to PML
[12–14]. There has been considerable interest in the use of
retinoids in breast cancer treatment but the clinical results
of such trials have been disappointing [15]. Factors that
contribute to the failure of these clinical trials include lack
of molecular determinants to predict retinoid sensitivity,
expression of enzymes that metabolize retinoids, wrong
choice of retinoids and epigenetic silencing of target RARs
[15–17] (RARα and RARβ) by promoter methylation
[15, 17–20]. Since ligand-activated RARs trans-activate
complex gene networks to promote differentiation and
other anti-tumor effects [11], their reduced expression
prevents endogenous and exogenous retinoids from
proper function. This problem can possibly be overcome
by employing strategies to increase expression of RARα/β.
Here we report the ability of SID decoys to activate
RARα/β receptor specific pathways and their potential use
in combination with RARα-selective agonist AM80 as a
novel adjuvant therapy to treat metastatic TNBC.
RESULTS
SID peptide increases expression of RARβ2,
endogenous retinoic acid levels and activates
RAR-target promoters
We have previously shown that interference with the
protein interactions of PAH2 domain of Sin3A protein by
stable expression of SID peptide in MDA-MB-231 cells,
induced expression of RARβ2 [4]. Consistent with this,
short term treatments of MDA-MB-231 cells with 31-mer
SID peptide [6] increased the expression of RARβ2 by 1.5-
fold after 24 h, 8.6-fold after 72 h and 24-fold after 144 h
of treatments (Figure 1A). A significant increase in RARβ2
expression was also observed in mouse TNBC cells, 4T1,
treated with SID peptide (Supplementary Figure S1). In
addition to this, in a microarray experiment in MDA-
MB-231 cells treated with SID peptide [6], pathway
analysis revealed down-regulation of several genes like
STRA6, DUSP1, HOXA3 and EGR1 that are known RAR
γ target genes (Supplementary Table S1). To further test the
effect of SID peptide on retinoid function, we quantified
the endogenous levels of retinoids in two TNBC cell lines
(MDA-MB-231 and 4T1) treated with SID peptide. LC-
MS/MS was performed to measure total retinoic acid (RA)
production in the presence of 2 µM RBP4-retinol with or
without SID treatment. In comparison to cells treated with
scrambled peptide control (Scr), SID treatment induced
50% increase in RA production in human MDA-MB-231
and 21% increase in mouse 4T1 cells (Figure 1B). For
quantification of the neutral retinoids like retinol (ROL)
and retinyl ester (RE), HPLC-UV was used. Compared to
Scr-treated cells, there were no significant changes in ROL
or RE in cells treated with SID peptide (Supplementary
Figure S2A). Consistent with these results we have
previously reported a SID-induced increase in expression
of a retinoid target gene, CRBP1 [4], which is known to
increase RA biosynthesis [21].
To test if SID-induced increase in RA also leads to
activation of RAR-regulated transcription, three TNBC
cells lines (D3H2LN, a MDA-MB-231 variant; MDA-
MB-157 and MMTV-Myc) were transiently transfected
with retinoic acid response element (RARE) driven GFP
plasmid and then treated with SID or control scrambled
(Scr) peptide. Mean fluorescence intensity of GFP was
used to measure the activation of RARE-driven GFP
expression (Figure 1C). In all the three cell lines tested,
in comparison to the control, significant increase was
observed in GFP expression upon SID treatment (41%
increase in D3H2LN, 78% in MDA-MB-157 and 75% in
MMTV-Myc; Figure 1C). Together our results demonstrate
that SID peptide can activate retinoid signaling in TNBC
cells.
C16, a small molecule inhibitor mimetic of SID
peptide, increases expression of RARβ2 and,
in combination with RARα agonist AM80,
enhances retinoid signaling
The long-term goal of our laboratory is to translate
the novel findings on SID function into treatment for
patients with TNBC. For that purpose, we screened
and reported [7] that Avermectins are SID peptide
mimetics. Although, potent, these compounds are not
readily soluble. Hence, we conducted structure-guided
computational screen to identify compounds that are
more soluble and hence better suited for studying the
anti-tumor effects of SID decoys in vivo. An extensive
structure-activity relationship (SAR) study of 115,000
small molecule compounds was conducted as reported
previously [7], to identify small molecule inhibitors
(SMIs) with enhanced and selective binding to the target
mSin3A PAH2 domain. Amongst the initial group of
candidate SMIs, we identified compound 16 (C16; IUPAC
name: 4-(2,3-Dichlorophenyl)-3a,4,5,9b-tetrahydro-3H-
cyclopenta[c]quinoline-6-carboxylic acid) that exhibited
binding affinity Ki of 23.6 µM in fluorescence anisotropy
competition assay (Supplementary Figure S3A). A

detailed NMR titration (as previously described (Kwon
et al., 2015)), established that C16 interacts with PAH2
through residues critical for the interaction between
SIN3A PAH2 and the MAD SID domain (Supplementary
Figure S3B). Consistent with its function as a PAH2
blocker, proximity ligation assay also confirmed that
C16 disrupts the interaction between Sin3A and MAD1
(Supplementary Figure S3C). Similar to previous reports
for SID decoys, treating MDA-MB-231 cells with C16 for
72 h significantly increased the expressions of CDH1 and
ESR1 (Supplementary Figure S3D).
Treatment of MDA-MB-231 cells with 200 nM
C16, resulted in significant increase in expression of
RARα2 (2.1-fold) and β2 (3.6-fold) mRNA (Figure 2A).
Moreover, there was an increase in the ratio of RARα2/
RARγ1 (1.6-fold over the untreated) and RARβ2/RARγ1
(2.7-fold) expressions (Figure 2B), suggesting possible
activation of RARα/β specific pathways. At the protein
level, significant increase was observed in RARβ, a
RARα target gene (Figure 2C). No significant increase
in the total RARα protein was observed in C16-treated
cells. Differences in protein levels of specific RARα
isoforms could not be verified due to lack of isoform-
targeted antibodies. Similar to the SID peptide, C16
also induced 24% increase in RA production in MDA-
MB-231 cells while in 4T1 and MMTV-Myc cells 50%
and 27% increases were observed (Figure 2D). No change
in levels of ROL or RE was observed (Supplementary
Figure S2B). Further, in the presence of an RARα-specific
antagonist, RO41-5253, C16 treatments neither activated
Figure 1: SID peptide increases expression of RARβ2, endogenous retinoic acid levels and activates RARE-driven
promoter. (A) qRT PCR for expression of RARβ2 in MDA-MB-231 cells treated with 2.5 µM SID peptide for 24 h, 72 h and 144 h.
Error bars represent mean ± SD (n = 3). SCR vs SID, *p = 0.0110 (24 h); ***p < 0.0001 (72 h and 144 h), unpaired t-test. (B) Endogenous
retinoic acid levels in MDA-MB-231 and 4T1 cells, untreated or treated with 2.5 µM SCR or SID peptides. Error bars represent mean ± SD
(n = 3). SCR versus SID, *p = 0.0145 (MDA-MB-231); **p = 0.0051 (4T1); unpaired t-test. (C) Expression of RARE-driven GFP reporter
in MDA-MB-231 variant D3H2LN, MDA-MB-157 and MMTV-Myc cells treated with 2.5 µM SCR or SID peptides. Error bars represent
mean ± SD (n = 3). SCR vs SID, *p = 0.0219 (D3H2LN); **p = 0.004 (MDA-MB-157); ***p = 0.00031 (MMTV-Myc), unpaired t-test.

the RARE-GFP reporter (Supplementary Figure S4A) nor
increased RARβ2 expression (Supplementary Figure S4B),
suggesting C16-induced increase in RAR signaling is
RARα-dependent.
To test the consequence of the C16-effect on RA
production we examined the activation of a RARE-driven
gene promoter in cells treated with C16. We also tested
whether the RARE-driven transactivation is enhanced
by a RARα specific agonist AM80; a drug approved for
treatment of ATRA resistant APL in Japan [22–24]. MDA-
MB-231 cells were transiently transfected with RARE-
driven GFP reporter plasmid and treated with C16 and
AM80, either alone or in combination. C16 treatments
increased the expression of the RARE-GFP reporter
by 84% (Figure 2E). Addition of AM80, increased the
reporter activity to 300% (Figure 2E). Taken together our
results clearly demonstrate the ability of a SID decoy, in
combination with retinoids like AM80, to increase ligand-
mediated activation of RAR signaling.
C16 in combination with AM80 induces acinar
morphogenesis and inhibits tumorsphere
formation
We have previously reported that SID decoys
can induce morphogenesis and cellular differentiation
in 3D cultures of TNBC cells in basement membrane
matrix [4, 6]. The fact that our prior work linked RARα
activation pathway to differentiation and cell death
[25] and that we show here (Figure 2) ligand mediated
activation of RARs, compelled further study of the effect
of C16 in combination with RARα agonists on colony
morphogenesis. We used two RARα specific agonists,
AM80 and AM580. 4T1 cells cultured in Matrigel were
Figure 2: C16 modulates expression of RARs and enhances the retinoid signaling in combination with AM80. (A) qRT
PCR for expression of RARα1/2, RARβ1/2 and RARγ1 in MDA-MB-231 cells treated with 200 nM C16 for 96 h. Error bars represent mean
± SD (n = 3). DMSO versus C16, ***p < 0.0001, unpaired t-test. (B) Ratio of relative expression of RARs measured in (A). (C) Western
Blot for RARα, RARβ and RARγ1 in MDA-MB-231 cells treated with C16 at 200 nM for 96 h. (D) Endogenous retinoic acid levels in
three breast cancer cell lines (MDA-MB-231, 4T1 and MMTV-Myc) treated with 200 nM C16 for 6 days. Error bars represent mean ± SD
(n = 3). DMSO versus C16, **p = 0.0059 (MDA-MB-231); p = 0.0022 (4T1), p = 0.008 (MMTV-Myc), unpaired t-test. (E) Expression of
RARE- driven GFP reporter in MDA-MB-231 cells treated with 200 nM C16 and/or 200 nM AM80 (n = 2). DMSO versus C16-AM80,
*p < 0.05, one-way ANOVA.

treated with C16 alone, AM580, AM80 or the combination
of C16 with each of the agonists. C16 treated colonies
showed increased level of activated caspase-3 (Figure 3A
and 3B), a precursor to cavitation and acini formation
[4]. Treatment with the combination of C16 and AM580
further increased the levels of caspase-3 with evidence of
rudimentary acini formation (Figure 3A). These effects
were more profound with C16/AM80 combination in
which the colonies were small, non-invasive with features
resembling normal acinar morphogenesis (Figure 3B),
suggesting that C16/RARα agonist combination can
induce differentiation of TNBC cells cultured in matrix.
We next tested the effect of C16 in combination with
AM80, on tumorsphere formation. Tumorspheres were
generated by growing mouse TNBC cell lines 4T1 and
MMTV-Myc in suspension cultures. These cultures were
treated with DMSO (vehicle control), C16, AM80 or the
combination of the two. Compared to DMSO, C16 and
AM80 individually reduced the number of 4T1 tumorspheres
by 47% and the combination of C16 with AM80 by 80%
(Figure 3C). In MMTV-Myc cells, treatments with either
C16 or AM80 resulted in 54% and 35% decrease in
tumorsphere numbers, respectively, while the C16-AM80
combination decreased the number by 70% (Figure 3D).
Figure 3: C16 in combination with AM80 induces morphogenesis and inhibits tumorsphere formation. (A) Colony
morphogenesis of 4T1 cells cultured in 3D Matrigel with 200 nM C16 and or 200 nM AM580 for 10 d followed by staining with DAPI
(blue), caspase-3 (green) and phalloidin (red). Scale bar = 25 µm. Arrows indicate the partial acini formation. (B) Colony morphogenesis of
4T1 cells cultured in 3D matrigel with 200 nM C16 and/or 200 nM AM80 for 10 d followed by staining of the colonies with DAPI (blue)
and caspase-3 (green). Scale bar = 50 µm. Arrows indicate the partial acini formation. (C) Tumorsphere assay of 4T1 cells treated with
200 nM C16 and/or 200 nM of AM80 for 7 d. Results show numbers of tumorspheres. Error bars represent mean ± SD (n = 3). DMSO
versus C16 or AM80 or C16-AM80, ***p < 0.001, unpaired t-test. (D) Tumorsphere assay in MMTV-Myc cells treated with 200 nM C16
and/or 200 nM of AM80 for 7 d. Results show numbers of tumorspheres. Error bars represent mean ± SD (n = 3). DMSO versus C16,
**p = 0.0064; DMSO versus C16-AM80, **p = 0.0019, unpaired t-test.

C16 prevents development of Myc-driven
mammary hyperplasia
Although, testing of drug effects in colonies in
matrix or in tumorspheres are accepted in vitro correlates
of in vivo effects, current standards require that preclinical
studies be conducted in animal models. Hence we tested
the anti-tumor effect of C16 in MMTV-Myc oncomice – a
model for TNBC [26, 27]. Since C16 as a single agent
induced partial acinar morphogenesis and reduced the
number of tumorspheres (Figure 3A–3D), we hypothesized
that this effect might translate into induction of a more
normal-like mammary tree in MMTV-Myc model
in vivo. MMTV-Myc female oncomice present signs of
mammary gland hyperplasia at ~10 weeks of age, which
eventually progresses to ductal carcinoma in situ (DCIS)
and to frank tumors between weeks 16 and 32 [28]. The
hyperplastic phenotype is the result of c-Myc-driven
anomalous expansion of the mammary stem cells [27] and
the mammary stem cells are believed to be the targets of
malignant transformation [29]. The stem cell expansion is
believed to be the driver of the increased mammary ductal
tree side branching [30]. Ten week old virgin MMTV-Myc
mice were treated with C16 for 20 weeks, the mammary
glands removed and the side branching of the mammary
ductal tree was quantified as described previously
[31]. Treatment with C16 changed the mammary gland
morphology such that it resembled the mammary gland of a
wild type FVB/N virgin or involuted mammary ductal tree
(Figure 4A). This treatment reduced the density of the side
branches (ductal tree hyperplasia) by ~3-fold (Figure 4B).
Because C16 alone significantly reduced tumorsphere
generation (Figure 3D) we examined whether it will also
reduce primary tumor development and increase survival.
A small cohort (n = 8 per experimental group) of MMTV-
Myc females was treated with C16 (or DMSO as control)
and monitored for appearance of palpable tumors. Of the
8 DMSO-treated mice 5 developed tumors in week 21
while only one of the eight C16 treated females developed
a tumor on week 28.5. Kaplan Meyer analysis showed that
treatment with C16 alone significantly increased tumor-
free survival (Figure 4C).
Treatment with C16-RARα agonist inhibits
metastases and increases disease-free survival
We next asked whether the ability of C16 in
combination with a RARα agonist to induce differentiation
of TNBC cells, to block tumorsphere formation, and to
inhibit mammary ductal tree hyperplasia, will translate
into anti-tumor and anti-metastatic effect and will increase
survival. To answer these important questions more
broadly, the experiments were carried out in two TNBC
mouse models; the well-established TNBC model of
mouse 4T1 cells, which grow rapidly and closely mimic
tumor growth and metastatic spread of stage IV human
breast cancer, and the MMTV-Myc oncomice model. The
experiments were designed to either administer treatment
while the primary tumor was present and growing
(neo-adjuvant therapy), or after the primary tumor was
removed (adjuvant therapy). Because in the first setup,
there is presumably continuous dissemination of tumor
cells, inhibition of metastases would suggest that both
dissemination and metastatic growth might be affected.
In the second setup mainly the ability to block metastatic
growth is being tested. To generalize our findings, we
tested two RARα-specific agonists, AM80 and AM580,
with slightly different structures and different potency in
some assays [32].
Balb/c mice bearing fast growing and rapidly
metastasizing 4T1 tumors were treated with C16 or
AM580 or C16 in combination with AM580. Treatment
for 17 days with C16 alone (but not with AM580
alone) reduced the mean tumor volume by 63%. The
combination reduced tumor volume by 90% (Figure 5A).
Lung metastases was significantly decreased with C16
alone (median = 0.5 vs 4 for DMSO) and appeared to be
significantly blocked in mice treated with the C16/AM580
combination as no macroscopic lung metastases was
visible (Figure 5B). To test whether these findings extend
to another model of TNBC, MMTV-Myc female mice
bearing palpable tumors were treated with the combination
of C16 and AM80 for 36 days, or with DMSO as control,
and the tumor growth was monitored. As compared to the
DMSO-treated group, C16/AM80 treatment reduced the
tumor volume by ~36% (Supplementary Figure S5A).
Importantly, in spite of the presence of a progressively
growing tumor, this treatment reduced lung metastases
by 90% (Supplementary Figure S5B), suggesting that
dissemination, or growth of metastases or both are being
inhibited by the C16/AM80 treatment.
The benefit of C16/AM80 combination treatment
in the post-surgical adjuvant setting was also evaluated.
This design assumes that if residual disease exists, it is
present in the form of disseminated cells, which most
likely also include cancer stem cells. To achieve this,
the primary tumors were dissected and only then the
treatment commenced. Following the resection of primary
tumors (~300 mm3
at day 17 post tumor cell inoculation),
developed by inoculating 4T1 cells in Balb/c mice, the
animals were treated with DMSO, C16, AM80 and C16/
AM80 once every day and followed for signs of cachexia
as a sign of disseminated disease. All animals in DMSO-
treated group showed symptoms of cachexia and were
euthanized between day 8 and 33 post primary tumor
resection with a median survival of 38 days (Figure 6A).
In the C16-treated group, symptoms of cachexia
appeared in three mice on day 10, 40 and 48 post-surgery
while two mice did not show any clinical symptoms and
were electively sacrificed at the end of the experiment
(Figure 6A). In the AM80 group, following cachexia,
the animals were euthanized between days 18 to 41 post-

surgery and the median survival was 45 days (Figure 6A).
The strongest effect was obtained with C16/AM80
adjuvant treatment wherein all mice (but one which died
of cancer unrelated cause) had no symptoms of clinical
disease or toxicity and were electively sacrificed on
day 80 of treatment (Figure 6A). Following euthanasia,
lungs were excised from each animal and examined for
metastases. Compared to DMSO, treatment with either
C16 or AM80 decreased lung metastases by 90% and 54%
respectively (median values, C16 = 7; AM80 = 30 vs 65.5
for DMSO). Remarkably, no evidence of macroscopic
lung metastases was detected in lungs isolated from mice
receiving C16-AM80 combination treatment (Figure 6B).
Whether the blocking of metastases is achieved through
blocking of cancer stem cells (CSCs) (as would be
suggested by the in vitro effects) remains to be determined.
In parallel, bone marrow aspirates from both femurs of
each mouse were cultured in a colony assay to quantify
disseminated tumor cells (DTCs). C16 either alone, or in
combination with AM80, successfully eradicated bone
marrow DTCs. Interestingly, AM80 even as a single agent
resulted in a significant 92% reduction in bone marrow
Figure 4: C16 prevents development of Myc-driven mammary hyperplasia. (A) Representative images of the mammary
gland architecture of 30 weeks old virgin MMTV-Myc oncomice (n = 16/group) treated with DMSO or C16 for 20 weeks. The far right
panel shows an age-matched control of mammary gland isolated from healthy virgin FVB mouse. (B) Graph showing the number of side
branches per mm of the mammary glands (n = 32) isolated in (A). DMSO versus C16, ***p < 0.0001, one-way ANOVA. (C) Kaplan-Meier
plot showing tumor-free survival of MMTV-Myc oncomice treated with DMSO or C16 (n = 8/group). DMSO versus C16, *p = 0.0272, p,
logrank test.

DTCs (Figure 6C). Similar experiment was performed
using atRA instead of AM80. In contrast to AM80, atRA
either as a single agent or in combination with C16 did
not decrease lung metastases, DTCs or improve overall
rate of survival compared to C16 alone, as measured by
Kaplan Meir plot (Figure 6D–6F). The effect of C16 or
AM80 as single agents, or as a combination, on metastases
(after primary tumor resection) was also tested in MMTV-
Myc mice. Under this setup, all 3 treatments, C16 alone,
AM80 alone and the combination of the two produced a
significant reduction in lung metastases (Supplementary
Figure S5C).
DISCUSSION
We show here that by using the combination
of SID decoys and RARα agonist it is possible to help
“cure” mice of a TNBC-like tumor. This treatment works
in a neoadjuvant and adjuvant setting, it eliminates
disseminated cells in the bone marrow, blocks metastases
and extends survival to possibly achieve a normal life
span. Patients with TNBC tumors frequently fail standard
chemotherapy, and although recent attempts at treatment
with PARP inhibitors, PI3K inhibitors and modulators
of the p53 family members have shown some early
promise [33], no clinically validated drug target exist
that are effective as neo-adjuvant or adjuvant therapy
and frequently the tumor relapses locally, regionally or as
systemic metastases.
Our approach was to restructure the epigenome
by disrupting protein interactions between Sin3A PAH2
domain and a set of SID-containing chromatin-associated
factors like MAD1 and PF1, [4, 6, 7], to promote
differentiation and inhibit EMT and CSCs. We now show
that SID decoys, and especially a small molecule C16
has a potent anti-tumor activity even as a single agent
(Figures 4–6) to block mammary hyperplasia, inhibit
tumor growth, tumor cells’ dissemination, metastases
and prolong tumor-free survival (Figures 4–6). In spite
of these impressive single agent results in preclinical
models, clinical experience teaches that even targeted
monotherapy is seldom successful in long term; so we
searched for combination therapy which will target TNBC
vulnerabilities. Our search revealed that treatment of
TNBC cells with C16 induces the expression of functional
RARs, specifically RARα2 and RARβ2 and sensitized
TNBC cells to retinoids (Figures 1–3). Our study is
consistent with the use of LSD1 inhibitors to alter the
epigenome and reactivate atRA-induced differentiation
in AML [34]. The normal function of retinoids to induce
differentiation is frequently altered in cancer, and
targeting the retinoid-dependent pathway and, possibly,
the cancer stem cells is an attractive anti-cancer strategy
[11, 15, 35, 36].
Although atRA treatment was shown to achieve
complete remission in APL, its success has not been
reproduced in other tumors, including metastatic breast
cancer [37]. There are several reasons for the loss of
retinoid responsiveness in tumors. First, well supported by
published evidence, is attributed to abnormal recruitment
of epigenetic enzymes (the HDAC–containing corepressor
complexes like Sin3A-HDAC complex and DNMTs)
that silences the retinoid-response genes such as RARα
and RARβ2 [15, 17–20]. Accordingly, it was possible to
restore RARα and RARβ2 expressions in cells treated with
HDAC inhibitors (TSA) or DNMT inhibitor (azacitidine)
and then inhibit cell proliferation by retinoid treatment
[38, 39].
Figure 5: C16 in combination with AM580 inhibits primary tumor growth and lung metastases. (A) Tumor progression
in Balb/c mice (n = 8) inoculated with 4T1 cells and then treated with DMSO or C16 or AM580 alone or in combination for 17 days, and
tumor volume quantified at the indicated times. DMSO versus C16, *p = 0.0273; DMSO versus C16-AM580, **p = 0.0032, unpaired t-test.
(B) Lungs from sacrificed animals (A) were isolated and metastatic foci counted. DMSO vs C16-AM580, *p = 0.0158, Mann-Whitney test.

Figure 6: Adjuvant treatment with C16-AM80 combination inhibits metastatic dissemination and increases disease-
free survival. (A) Kaplan-Meier analysis showing disease-free survival following removal of primary tumors in Balb/c mice (n = 5)
inoculated with 4T1 cells and treated with C16 and AM80 alone or in combination. DMSO versus C16, *p = 0.0343; DMSO versus C16-
AM80, **p = 0.0025, logrank test. (B) Lungs from sacrificed Balb/c mice inoculated as described in (A) were isolated and metastases
counted. DMSO versus, C16, *p = 0.0159, Mann-Whitney test; DMSO versusAM80, *p = 0.0286, Mann-Whitney test; DMSO versus C16-
AM80, **p = 0.0039, one-way ANOVA (Mann-Whitney could not be applied due to repeated values of zero for C16-AM80 treated mice).
(C) Quantification of the disseminated 4T1 tumor cells isolated from the bone marrow of sacrificed animals from (A). DMSO versus, C16,
**p < 0.01; DMSO versus C16-AM80, **p < 0.01, one-way ANOVA. (D) Kaplan-Meier analysis showing disease-free survival following
removal of primary tumors in Balb/c mice inoculated with 4T1 cells and treated with C16 and atRA alone or in combination. DMSO versus
C16, *p = 0.02345, logrank test. (E) Lungs from sacrificed Balb/c mice inoculated as described in (D) were isolated and quantified for the
number of metastases observed. DMSO versus C16 or C16-atRA, *p = 0.0286, Mann-Whitney test. (F) Quantification of the disseminated
4T1 tumor cells isolated from the bone marrow of sacrificed animals from (D).

However, other considerations limit the use of
retinoids beyond APL. First atRA used to treat APL
activates all the RARs, including RARγ1, which was
shown to activate pro-oncogenic signals and CSC
proliferation in breast cancer [22, 40]. We have previously
reported an imbalance in RARα/RARγ expression
could be reversed by treatment with RARα agonist and
activation of RARβ2 in Myc-driven TNBC [25]. In fact,
activation of RARα has been shown to be sufficient for
achieving retinoid response in both ER+ and ER– breast
cancer cells [41] while atRA, by activating PPAR β/δ,
induced tumorigenic effects [42, 43]. This becomes
especially important for ER– cells (like TNBC) that
express higher levels of PPAR β/δ than ER+ cells [15].
These considerations and the fact that the synthetic
retinoid AM80 (not atRA) is resistant to degradation by
stromal retinoid metabolizing enzymes CYP26A1 [41, 44]
and therefore expected to sustain higher plasma levels with
stronger anti-tumor activity, prompted us to consider it as
a partner drug for the SID decoys [24]. In agreement with
this, a remarkable difference was observed in anti-tumor
activity of AM80 versus atRA (Figure 6). The marked
increase in disease-free survival without measurable
toxicity observed in mice treated with C16-AM80 was
associated with eradication of disseminated tumor cells.
Moreover, the ability of C16 to inhibit mammary gland
hyperplasia further motivates investigations for its use in
chemoprevention.
The precise mechanism of action via which SID
decoys activate retinoid response is not clear. It is
debatable if the retinoid-target genes are also the primary
transcription targets of Sin3A; although earlier studies
have shown protein-protein interactions between Sin3A
and corepressors like NCoR and SMRT that directly
regulate the RAR-target promoters [45]. We predict
that the anti-tumor effects of C16-AM80 are due to
enhanced retinoid-regulated transcription activation
although identification of other genes within this complex
network warrant further investigations. Further, retinoid
signaling regulates mammary epithelial cell growth and
differentiation via activation of both retinoic acid (RA)
and retinoid X receptors (RXRs) [15]. Studies that venture
into the contributions of RXRs in the observed phenotype
of C16 will be critical; especially because of the known
interaction between RXRα and the PAH2-interacting
transcription factor TGIF1 that is known to inhibit retinoid
signaling [46, 47]. However, we also cannot rule out the
possibility that the enhanced sensitivity of C16-treated
TNBC cells to retinoids could be an indirect effect of
Sin3A functions in regulation of pathways that crosstalk
with retinoid signaling like estrogen and Wnt signaling
that have previously been shown to be affected by SID
decoys [4, 6, 7]. Further, SID decoys favor transition from
a basal to luminal phenotype [4] that is more retinoid
sensitive [48]. Nonetheless, these data establish existence
of a crosstalk between Sin3A and retinoid signaling and
targeting Sin3A by C16 in combination with AM80 may
be a promising adjuvant therapy for treating or preventing
metastatic TNBC.
MATERIALS AND METHODS
Cell culture
The mouse metastatic mammary 4T1 tumor cell
line (Cat# CRL-2539) and human MDA-MB-231 breast
adenocarcinoma cell line (Cat# HTB-26) were purchased
from the American Type Culture Collection (ATCC).
The MDA-MB-231-Luc-D3H2LN Bioware (D3H2LN)
cell line [49] was purchased from PerkinElmer (Cat#
119369). The mouse mammary tumor MMTV-Myc cell
line has been previously reported [25, 50]. Cell lines were
authenticated by short tandem repeat (STR) profiling in
accordance with the standard ASN-0002-2011 in April
2015 and March 2016 (DDC Medical). 4T1 cells were
maintained in RPMI supplemented with 10% fetal bovine
serum (FBS) and 1% Antibiotic-Antimycotic solution
(Invitrogen). The MDA-MB-231 cell line was maintained
in DMEM supplemented with 10% FBS, 1% GlutaMAX
(Invitrogen), 10 mM HEPES, 1 mM sodium pyruvate,
non-essential amino acids and 1% antibiotic-antimycotic
solution. MMTV-Myc cells were cultured in DMEM/F12
medium supplemented with 5% FBS, 1% GlutaMAX,
10 mM HEPES, and 1% antibiotic-antimycotic solution.
Peptides and C16
MAD-SID peptide (SID: YGRKKRRQGGG-
VRMNIQMLLEAADYLERRER), MAD scrambled
peptide (Scr: YGRKKRRQGGGEQRARRIMERLLE
YNMVADL) [6] were synthesized to a purity level
of 95% as assessed by analytical reversed phase-high
performance liquid chromatography (BioSynthesis, Inc.
Lewisville, TX). C16 (IUPAC: 4-(2, 3-Dichlorophenyl)-
3a, 4, 5, 9b-tetrahydro-3H-cyclopenta[c]quinoline-6-
carboxylic acid) was initially screened and supplied by
laboratory of Dr. Ming-Ming Zhou at Icahn School of
Medicine at Mount Sinai, New York. Additional C16 was
purchased from Mcule, Inc (Palo Alto, CA) and Ambinter
(c/o Greenpharma, Orleans, France).
Immunofluorescence
Cells were cultured on 8-well chambers (BD
Biosciences) and fixed with 4% paraformaldehyde/PBS
for 15 min at room temperature. For 3D cultures cells
were seeded (3 × 103
/well) in quadruplicate onto Matrigel
(BD Biosciences) beds in 8-well culture slides to prepare
three-dimensional cultures as described earlier [61].
The media was changed every 48 h for 8 consecutive
days. Colony morphology was determined by phase-
contrast microscopy. For immunostaining, cells were

permeabilized with 0.5% Triton X-100/PBS and blocked
with 10% normal goat serum (Invitrogen) in PBS for 1 h.
Primary antibodies were incubated overnight at 4ºC in
blocking buffer and washed 3 times with washing buffer
(0.05% Triton X-100/PBS) and once with PBS. Secondary
antibodies (dilution 1:200 in 1% normal goat serum/PBS)
were added for 1 h and then washed. The samples were
then mounted with ProLong Gold antifade reagent with
DAPI (Molecular Probes/Invitrogen, CA), following the
manufacturer instructions. All incubations and washes
were done at 4 or 25ºC as required. Confocal microscopy
was performed using a Leica SP5 confocal microscope
at the Shared Instrumentation facility of department of
Hematology at Mount Sinai School of Medicine, NY.
Identification of C16 as small molecule mimetic
of SID
Computational screening of chemical compounds
was conducted in the laboratory of Prof. Ming-Ming Zhou
at Icahn School of Medicine at Mount Sinai, New York,
as described previously in Kwon et al., 2015. Top scoring
candidate SMIs were tested for their binding to the SIN3A
PAH2 domain experimentally by NMR spectroscopy as
previously described [7]. The binding affinity of C16
for SIN3A was assessed in a fluorescence anisotropy
competition assay as described previously [6].
Proximity ligation assay
MDA-MB-231 cells plated onto coverslips in 12
well plates with or without C16 treatment were stained
with monoclonal SIN3A (sc-5299) 1:100 and polyclonal
MAD1 (sc-222) 1:1000 following the Duolink protocol
according to the manufacturer’s instructions (Olink
Bioscience) except utilizing 1% BSA in PBS as a blocking
reagent and carrying out initial washes in PBS. Cells were
counterstained in To-pro-3-iodide in PBS, 3 × 5 min
washes at RT and mounted in Vectashield mounting
medium (vector labs). Images were collected on a Zeiss
LSM700 confocal microscope and the Duolink software
was utilized to quantitate the signals.
RARE reporter assay
TNBC cell lines described were treated with
2.5 µM SCR or SID, 200 nM C16, 200 nM AM80 for
96 h and transiently transfected with 4 µg of DNA of
the RARE-EGFP reporter [51] to detect the activation
of RAR-associated signaling by the increase in EGFP
fluorescence by fluorescence microscopy and FACS
analysis. All transfections were done using Turbofect
(ThermoScientific) in accordance with the manufacturer’s
instructions. In experiments involving RARα antagonist,
MDA-MB-231 cells were treated with 500 nM RO41-
5253 (Sigma Aldrich) alone or in combination with C16
for 96 h followed by RARE-GFP reporter assay described
above.
Quantification of retinoic acid, retinyl esters and
retinol
MDA-MB-231 and 4T1 cells were assayed for impact
of SID peptide, and MDA-MB-231, 4T1 and MMTV-Myc
cells were assayed for effect of C16 on retinoic acid (RA)
production. One set of cells were treated with DMSO,
2.5 µM SCR or SID peptide, 200 nM C16 for 96 h. In
a second set each treatment was combined with 2 mM
RBP4-ROL for the last 48 h. Media was collected from
cell cultures and cells were lysed. Media and cell lysates
were frozen and kept at – 80o
C until extraction. Media and
cell lysates from each condition were assayed separately
for retinoid content. Retinoids standards were purchased
from Sigma-Aldrich (St. Louis, MO, USA) and handled
under yellow light. Media and cell lysates were extracted
under yellow light using a 2-step liquid-liquid extraction, as
described previously [52–54]. Retinoids were quantified in
extracted samples within 1 day by liquid chromatography-
tandem mass spectrometry (LC-MS/MS) for RA isomers
using an AB Sciex 5500 QTRAP or by high-performance
liquid chromatography with ultraviolet detection (HPLC-
UV) for neutral retinoids (retinol, REs) using a Waters
AQUITY UPLC [52–55]. Retinoid content was normalized
per milliliter (media or cell lysate extracted).
Tumorspheres assay
4T1 or MMTV-Myc cells (1 × 103
) were plated
in ultra-low adhesion 6-well plates (Corning, Corning,
NY) and incubated in serum-free F12/DMEM (Cellgro)
supplemented with 20 ng/ml EGF, 0.5% Matrigel and
1:50 B27 Supplement (Invitrogen) for 3 days at 37°C
in a humidified atmosphere of 5% CO2 and were then
treated with DMSO, 200 nM C16, 200 nM AM80 or the
combination of C16-AM80 for 7 days. The number of
tumorspheres per well (triplicates) were counted.
Quantitative real-time PCR
RNA was isolated using RNeasy Plus Mini Kit
(Qiagen), and cDNA was prepared using Superscript First-
Strand Synthesis System for RT-PCR Kit (Invitrogen)
or iTaqScript (Bio-Rad), all following manufacturers’
instructions. Quantitative real-time PCR was performed
using manufacturers’ instructions for QuantiTect SYBR
Green PCR (Qiagen) or iTaq Universal SYBR Green
Supermix (Bio-Rad) kits on Opticon or CFX96 machines
(Bio-Rad) with annealing temperature 54°C with 50–250 ng
cDNAand 6 pmols of gene specific primers (Supplementary
Table S2 and [6]) per reaction. For determination of gene
expression, the “delta-delta Ct method” was used relatively
to RPL30 housekeeping genes.

In vivo studies
Xenografts
Myc and 4T1 TNBC cells (5 × 104
cells/mouse)
were injected orthotopically in the mammary gland #4 or
#9 in 8 weeks old FVB or BALB/c females respectively
(n = 8 per experimental group). The FVB mice receiving
the Myc cells were treated with 72 ug/kg/day (200 nM)
C16 or DMSO (control). The BALB/c mice receiving the
4T1 cells were treated with DMSO, C16 (same dose used
for the Myc mice), AM580 or AM80 (0.3 mg/kg/day) or
the combination of C16 with either AM80 or AM580.
All the treatment started 24 h after the inoculation of the
cells. The mice were fed ad libitum. Tumor latency and
growth was measured. Tumor volumes were calculated
as ellipsoids (Dxd2
/2) by measuring the main diameter
(D) and the smaller diameter (d) and plotted vs. time
(days). The experiment was stopped when tumors in
the control group reached ~800 mm3
. At the end of the
experiments the lungs were stained with Bouin fixative
solutions (Sigma) and the overt lung metastases counted.
For experiments with post-surgery adjuvant treatments,
primary tumors were surgically removed when the tumor
volume was ~300 mm3
. Twenty-four hours post-surgery,
the mice were treated with above mentioned doses of
DMSO, C16, AM80 as single agents or in combination.
The mice were monitored for overall health and disease-
free survival and euthanized when signs of cachexia were
detected.
Lung and bone marrow metastases
dissemination studies
To determine the effect of the treatment described
above on the metastatic potential, BALB/c mice were
inoculated subcutaneous (s.c.) with 5 × 103
4T1 cells in
the interscapular space, when the tumors reached 300 mm3
were surgically ressected under anesthesia/analgesia
(ketamine/xylazine) following IACUC guidelines. The
day after surgery the mice received the treatments, DMSO,
AM80, C16 and C16/AM80 at the doses described. The
mice were monitored for signs of cachexia (changes in
weight, temperature, fur condition, activity, lethargy,
respiratory distress), when signs of cachexia were detected
the mice were euthanized and the lungs were fixed in
Bouin fixative solution and overt lung metastases counted.
Non-Parametric statistical analysis was used to determine
the significance of the differences observed. For measuring
the disseminated tumor cells aspirates were also collected
from the bone marrow of femur, washed with PBS and
selecting the 4T1 cells by culturing in the presence of
selection marker thioguanine as described earlier [56].
MMTV-Myc oncomice
To determine the effect of C16 on mammary ductal
tree hyperplasia, DCIS and pre-neoplastic lesions, MMTV-
Myc oncomice were used. Expression of c-Myc was
genotyped by tail PCR of 10-weeks old virgin MMTV-
Myc mice. The mice were then divided in 2 groups
(n = 16/group) and treated everyday with either DMSO
(0.01%) or C16 (72 μg/kg/day in 100 ul of PBS) for
20 weeks. At the end of the experiment the inguinal
mammary glands (#4 and #8, a total of 32 glands per
experimental group were analyzed) were removed and
fixed for whole mounts staining with carmine alum as
described previously [31, 40]. To determine the effect on
tumor progression MMTV-Myc females (n = 8) bearing
palpable tumors were treated, in this case, with the
combination of C16 (72 μg/kg/day) and AM80 (0.2 mg/
kg/day) for 35 weeks. Tumor growth was measured twice
a week. Mice were euthanized when tumors reached 1 cm3
in volume following which overt lung metastases were
counted and the inguinal glands that did not show palpable
tumors were recovered for mammary ductal tree analysis
by whole mounts as described above.
Statistical analyses
Statistical analyses were performed with GraphPad
Prism software (version 5.0). The experiments were
conducted with at least three independent experiments
unless otherwise mentioned. Where shown, p values were
calculated using the unpaired Student’s t-test, Mann-
Whitney or one-way ANOVA as indicated.
Study approval
All the in vivo work done with mice was done
following the IACUC guidelines. Animal Welfare
Assurance Number: A3111-01.
ACKNOWLEDGMENTS AND FUNDING
This study was supported by grants from the
National Institute of Health-National Cancer Institute
(R01CA158121), Samuel Waxman Cancer Research
Foundation, Triple Negative Breast Cancer Foundation
and the Chemotherapy Foundation. We thank Prof. Liliana
Ossowski (Professor Emeritus, Icahn School of Medicine
at Mount Sinai) for critical reading of the manuscript.
CONFLICTS OF INTEREST
The authors have declared that no conflicts of
interest exists.

REFERENCES
1. Hudis CA, Gianni L. Triple-negative breast cancer: an
unmet medical need. Oncologist. 2011; 16:1–11.
2. Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative
breast cancer. N Engl J Med. 2010; 363:1938–1948.
3. Joensuu H, Gligorov J. Adjuvant treatments for triple-
negative breast cancers. Ann Oncol. 2012; 23:vi40–45.
4. Farias EF, Petrie K, Leibovitch B, Murtagh J, Chornet MB,
Schenk T, Zelent A, Waxman S. Interference with
Sin3 function induces epigenetic reprogramming and
differentiation in breast cancer cells. Proc Natl Acad Sci
U S A. 2010; 107:11811–11816.
5. Bansal N, David G, Farias E, Waxman S. Emerging Roles
of Epigenetic Regulator Sin3 in Cancer. Adv Cancer Res.
2016; 130:113–135.
6. Bansal N, Petrie K, Christova R, Chung CY, Leibovitch BA,
Howell L, Gil V, Sbirkov Y, Lee E, Wexler J, Ariztia EV,
Sharma R, Zhu J, et al. Targeting the SIN3A-PF1
interaction inhibits epithelial to mesenchymal transition
and maintenance of a stem cell phenotype in triple negative
breast cancer. Oncotarget. 2015; 6:34087–34105. doi:
10.18632/oncotarget.6048.
7. Kwon YJ, Petrie K, Leibovitch BA, Zeng L, Mezei M,
Howell L, Gil V, Christova R, Bansal N, Yang S, Sharma R,
Ariztia EV, Frankum J, et al. Selective inhibition of SIN3
corepressor with avermectins as a novel therapeutic strategy
in triple negative breast cancer. Mol Cancer Ther. 2015;
14:1824–1836.
8. Widschwendter M, Berger J, Muller HM, Zeimet AG,
Marth C. Epigenetic downregulation of the retinoic acid
receptor-beta2 gene in breast cancer. J Mammary Gland
Biol Neoplasia. 2001; 6:193–201.
9. Yang Q, Sakurai T, Kakudo K. Retinoid, retinoic acid
receptor beta and breast cancer. Breast Cancer Res Treat.
2002; 76:167–173.
10. Zhu W, Qin W, Hewett JE, Sauter ER. Quantitative
evaluation of DNA hypermethylation in malignant and
benign breast tissue and fluids. Int J Cancer. 2010; 126:
474–482.
11. Tang XH, Gudas LJ. Retinoids, retinoic acid receptors, and
cancer. Annu Rev Pathol. 2011; 6:345–364.
12. Petrie K, Zelent A, Waxman S. Differentiation therapy of
acute myeloid leukemia: past, present and future. Curr Opin
Hematol. 2009; 16:84–91.
13. Hu J, Liu YF, Wu CF, Xu F, Shen ZX, Zhu YM, Li JM,
Tang W, Zhao WL, Wu W, Sun HP, Chen QS, Chen B,
et al. Long-term efficacy and safety of all-trans retinoic
acid/arsenic trioxide-based therapy in newly diagnosed
acute promyelocytic leukemia. Proc Natl Acad Sci U S A.
2009; 106:3342–3347.
14. Huang ME, Ye YC, Chen SR, Chai JR, Lu JX, Zhoa L,
Gu LJ, Wang ZY. Use of all-trans retinoic acid in the
treatment of acute promyelocytic leukemia. Blood. 1988;
72:567–572.
15. Garattini E, Bolis M, Garattini SK, Fratelli M, Centritto F,
Paroni G, Gianni M, Zanetti A, Pagani A, Fisher JN,
Zambelli A, Terao M. Retinoids and breast cancer: from
basic studies to the clinic and back again. Cancer Treat Rev.
2014; 40:739–749.
16. Sonneveld E, van den Brink CE, van der Leede BM,
Schulkes RK, Petkovich M, van der Burg B, van der
Saag PT. Human retinoic acid (RA) 4-hydroxylase (CYP26)
is highly specific for all-trans-RA and can be induced
through RA receptors in human breast and colon carcinoma
cells. Cell Growth Differ. 1998; 9:629–637.
17. Sirchia SM, Ferguson AT, Sironi E, Subramanyan S,
Orlandi R, Sukumar S, Sacchi N. Evidence of epigenetic
changes affecting the chromatin state of the retinoic acid
receptor beta2 promoter in breast cancer cells. Oncogene.
2000; 19:1556–1563.
18. Farias EF, Arapshian A, Bleiweiss IJ, Waxman S, Zelent A,
Mira YLR. Retinoic acid receptor alpha2 is a growth
suppressor epigenetically silenced in MCF-7 human breast
cancer cells. Cell Growth Differ. 2002; 13:335–341.
19. Lustberg MB, Ramaswamy B. Epigenetic targeting in breast
cancer: therapeutic impact and future direction. Drug News
Perspect. 2009; 22:369–381.
20. Liu Y, Lee MO, Wang HG, Li Y, Hashimoto Y, Klaus M,
Reed JC, Zhang X. Retinoic acid receptor beta mediates
the growth-inhibitory effect of retinoic acid by promoting
apoptosis in human breast cancer cells. Mol Cell Biol. 1996;
16:1138–1149.
21. Uchio K, Tuchweber B, Manabe N, Gabbiani G,
Rosenbaum J, Desmouliere A. Cellular retinol-binding
protein-1 expression and modulation during in vivo and
in vitro myofibroblastic differentiation of rat hepatic stellate
cells and portal fibroblasts. Lab Invest. 2002; 82:619–628.
22. Tobita T, Takeshita A, Kitamura K, Ohnishi K, Yanagi M,
Hiraoka A, Karasuno T, Takeuchi M, Miyawaki S, Ueda R,
Naoe T, Ohno R. Treatment with a new synthetic retinoid,
Am80, of acute promyelocytic leukemia relapsed from
complete remission induced by all-trans retinoic acid.
Blood. 1997; 90:967–973.
23. Miwako I, Kagechika H. Tamibarotene. Drugs Today
(Barc). 2007; 43:563–568.
24. Coombs CC, Tavakkoli M, Tallman MS. Acute
promyelocytic leukemia: where did we start, where are we
now, and the future. Blood Cancer J. 2015; 5:e304.
25. Bosch A, Bertran SP, Lu Y, Garcia A, Jones AM,
Dawson MI, Farias EF. Reversal by RARalpha agonist
Am580 of c-Myc-induced imbalance in RARalpha/
RARgamma expression during MMTV-Myc tumorigenesis.
Breast Cancer Res. 2012; 14:R121.
26. Hanahan D, Wagner EF, Palmiter RD. The origins of oncomice:
a history of the first transgenic mice genetically engineered to
develop cancer. Genes Dev. 2007; 21:2258–2270.
27. Moumen M, Chiche A, Decraene C, Petit V, Gandarillas A,
Deugnier MA, Glukhova MA, Faraldo MM. Myc is

required for beta-catenin-mediated mammary stem cell
amplification and tumorigenesis. Mol Cancer. 2013; 12:132.
28. Hutchinson JN, Muller WJ. Transgenic mouse models of
human breast cancer. Oncogene. 2000; 19:6130–6137.
29. Chen SY, Huang YC, Liu SP, Tsai FJ, Shyu WC, Lin SZ. An
overview of concepts for cancer stem cells. Cell Transplant.
2011; 20:113–120.
30. Lamb R, Harrison H, Clarke RB. Mammary development,
carcinomas and progesterone: role of Wnt signalling. Ernst
Schering Found Symp Proc. 2007; 1–23.
31. Cohn E, Ossowski L, Bertran S, Marzan C, Farias EF.
RARalpha1 control of mammary gland ductal morphogenesis
and wnt1-tumorigenesis. Breast Cancer Res. 2010; 12:R79.
32. Oikawa T, Okayasu I, Ashino H, Morita I, Murota S,
Shudo K. Three novel synthetic retinoids, Re 80, Am 580
and Am 80, all exhibit anti-angiogenic activity in vivo. Eur
J Pharmacol. 1993; 249:113–116.
33. Palma G, Frasci G, Chirico A, Esposito E, Siani C,
Saturnino C, Arra C, Ciliberto G, Giordano A, D’Aiuto M.
Triple negative breast cancer: looking for the missing
link between biology and treatments. Oncotarget. 2015;
6:26560–26574. doi: 10.18632/oncotarget.5306.
34. Schenk T, Chen WC, Gollner S, Howell L, Jin L,
Hebestreit K, Klein HU, Popescu AC, Burnett A, Mills K,
Casero RA, Jr., Marton L, Woster P, et al. Inhibition of the
LSD1 (KDM1A) demethylase reactivates the all-trans-
retinoic acid differentiation pathway in acute myeloid
leukemia. Nat Med. 2012; 18:605–611.
35. Bobele GB, Garnica A, Schaefer GB, Leonard JC,
Wilson D, Marks WA, Leech RW, Brumback RA.
Neuroimaging findings in Alexander’s disease. J Child
Neurol. 1990; 5:253–258.
36. Gudas LJ, Wagner JA. Retinoids regulate stem cell
differentiation. J Cell Physiol. 2011; 226:322–330.
37. Sutton LM, Warmuth MA, Petros WP, Winer EP.
Pharmacokinetics and clinical impact of all-trans retinoic
acid in metastatic breast cancer: a phase II trial. Cancer
Chemother Pharmacol. 1997; 40:335–341.
38. Touma SE, Goldberg JS, Moench P, Guo X, Tickoo SK,
Gudas LJ, Nanus DM. Retinoic acid and the histone
deacetylase inhibitor trichostatin a inhibit the proliferation
of human renal cell carcinoma in a xenograft tumor model.
Clin Cancer Res. 2005; 11:3558–3566.
39. Fazi F, Travaglini L, Carotti D, Palitti F, Diverio D,Alcalay M,
McNamara S, Miller WH Jr, Lo Coco F, Pelicci PG, Nervi C.
Retinoic acid targets DNA-methyltransferases and histone
deacetylases during APL blast differentiation in vitro and
in vivo. Oncogene. 2005; 24:1820–1830.
40. Lu Y, Bertran S, Samuels TA, Mira-y-Lopez R, Farias EF.
Mechanism of inhibition of MMTV-neu and MMTV-wnt1
induced mammary oncogenesis by RARalpha agonist
AM580. Oncogene. 2010; 29:3665–3676.
41. Schneider SM, Offterdinger M, Huber H, Grunt TW.
Activation of retinoic acid receptor alpha is sufficient for
full induction of retinoid responses in SK-BR-3 and T47D
human breast cancer cells. Cancer Res. 2000; 60:5479–5487.
42. Morgan E, Kannan-Thulasiraman P, Noy N. Involvement
of Fatty Acid Binding Protein 5 and PPARbeta/delta in
Prostate Cancer Cell Growth. PPAR Res. 2010; 2010.
43. Schug TT, Berry DC, Toshkov IA, Cheng L, Nikitin AY,
Noy N. Overcoming retinoic acid-resistance of mammary
carcinomas by diverting retinoic acid from PPARbeta/delta
to RAR. Proc Natl Acad Sci U S A. 2008; 105:7546–7551.
44. Osanai M, Petkovich M. Expression of the retinoic acid-
metabolizing enzyme CYP26A1 limits programmed cell
death. Mol Pharmacol. 2005; 67:1808–1817.
45. Nagy L, Kao HY, Chakravarti D, Lin RJ, Hassig CA,
Ayer DE, Schreiber SL, Evans RM. Nuclear receptor
repression mediated by a complex containing SMRT,
mSin3A, and histone deacetylase. Cell. 1997; 89:373–380.
46. Bartholin L, Powers SE, Melhuish TA, Lasse S,
Weinstein M, Wotton D. TGIF inhibits retinoid signaling.
Mol Cell Biol. 2006; 26:990–1001.
47. Wotton D, Knoepfler PS, Laherty CD, Eisenman RN,
Massague J. The Smad transcriptional corepressor TGIF
recruits mSin3. Cell Growth Differ. 2001; 12:457–463.
48. Centritto F, Paroni G, Bolis M, Garattini SK, Kurosaki M,
Barzago MM, Zanetti A, Fisher JN, Scott MF, Pattini L,
Lupi M, Ubezio P, Piccotti F, et al. Cellular and molecular
determinants of all-trans retinoic acid sensitivity in breast
cancer: Luminal phenotype and RARalpha expression.
EMBO Mol Med. 2015; 7:950–972.
49. Jenkins DE, Hornig YS, Oei Y, Dusich J, Purchio T.
Bioluminescent human breast cancer cell lines that permit
rapid and sensitive in vivo detection of mammary tumors
and multiple metastases in immune deficient mice. Breast
Cancer Res. 2005; 7:R444–454.
50. Stewart TA, Pattengale PK, Leder P. Spontaneous mammary
adenocarcinomas in transgenic mice that carry and express
MTV/myc fusion genes. Cell. 1984; 38:627–637.
51. Richards B, Karpilow J, Dunn C, Zharkikh L, Maxfield A,
Kamb A, Teng DH. Creation of a stable human reporter
cell line suitable for FACS-based, transdominant genetic
selection. Somat Cell Mol Genet. 1999; 25:191–205.
52. Kane MA, Napoli JL. Quantification of endogenous
retinoids. Methods Mol Biol. 2010; 652:1–54.
53. Kane MA, Chen N, Sparks S, Napoli JL. Quantification of
endogenous retinoic acid in limited biological samples by
LC/MS/MS. Biochem J. 2005; 388:363–369.
54. Kane MA, Folias AE, Wang C, Napoli JL. Quantitative
profiling of endogenous retinoic acid in vivo and in vitro by
tandem mass spectrometry. Anal Chem. 2008; 80:1702–1708.
55. Kane MA, Folias AE, Napoli JL. HPLC/UV quantitation of
retinal, retinol, and retinyl esters in serum and tissues. Anal
Biochem. 2008; 378:71–79.
56. Pulaski BA, Ostrand-Rosenberg S. Mouse 4T1 breast tumor
model. Curr Protoc Immunol. 2001; Chapter 20:Unit 20 22.

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